First, with respect to abortion, Rand Paul believes that from the point of conception, human life is entitled to state protection. Sullum concludes that this position “can be defended on libertarian grounds” once one “accept[s] the premise that a fetus is a person with a right to life.”
Rand Paul is correct (and Sullum is right to implicitly recognize) that abortion is not self-evidently beyond the purview of government. To the contrary, conflicts between rights-bearing individuals are quintessentially within that purview.
Government is the repository of collective force, the monopolistic holder of the privilege to enforce conformance to the collective will. According to most libertarians, that power is legitimately wielded to protect individual liberty, such as through the punishment and prevention of crimes like assault, battery, murder, rape, robbery, etc.
As an aside, from what I understand, even most anarchists endorse some sort of protocol for dealing with violence. One of my disagreements with anarchists is that I have never found anything semantically useful about calling those protocols anything other than “government.”
In any case, Paul and Sullum are therefore further correct that, if one accepts the unborn have rights, abortion is an issue that falls well within the purview of the state—because it involves a conflict between individual rights most of us readily acknowledge (the right to control one’s body versus the right to continue living).
As far as I know, however, nothing in libertarian doctrine answers the underlying, fundamental question of whether and when the unborn become rights-bearing. Only philosophy can tell us what attributes entitle a living entity to rights, and only medical science can tell us when the unborn develop those attributes.
I therefore disagree with Sullum in this very narrow respect: It would be better to say there is nothing inherently unlibertarian about Paul’s position on abortion than to say that libertarianism provides a basis for defending that position. Perhaps I am being pedantic. Perhaps it is an issue purely of semantics.
But it is one that matters to libertarians and non-libertarians alike.
Paul has some treacherous political terrain to navigate if he hopes to win both the GOP primary and a general election. If he wants the libertarian base to cross that terrain with him, he will probably need to articulate his positions with that level of finesse.
As a final note on the abortion issue, since non-libertarians often ask how we come down on this, I will go ahead and state my own position for the record. My own personal criteria for recognizing a living being’s entitlement to rights include some combination of the following: the ability to prefer existence over non-existence, the potential for high level sentience and the capacity to experience pain. I do not support interfering with a woman’s bodily autonomy from the moment of conception. I agree with Rand Paul, however, that fetuses become rights-bearing before the end of pregnancy and even before the end of the first trimester.
Second, on the issue of gay marriage, Sullum quotes Paul as lamenting that:
Ultimately, we could have fixed this a long time ago if we just allowed contracts between adults. We didn’t have to call it marriage, which offends myself and a lot of people…
From a libertarian perspective, there is no “we” here. There is no group properly endowed with the power to decide for everyone else what relationships get to be called “marriages.” It is for individuals to decide whether their relationship constitutes a “marriage,” and it is for other individuals to decide whether they agree with that characterization.
The issue is increasingly a litmus test precisely because it is so revealing of a candidate’s feelings about the relationship between individuals and government. It will be hard to sell a message of small government and liberty while simultaneously insisting that government should be so deeply involved in our lives as to define relationships and dictate how words are to be used.
In the past, Paul has indicated that he supports leaving it to the states to decide whether to recognize gay marriage. That position might solve Paul’s political problems as a federal candidate. But it is not inherently libertarian. Libertarians are, generally speaking, concerned with defining and limiting the exercise of force. That concern is not limited to federal government exercises of force.
Without more, Paul’s reliance on federalism requires libertarians to accept the following compromise: that while Paul believes state governments can interfere with private marriage, since he is not running for state office, we ought not worry overmuch about it. The argument is not without its merits. But it is also not libertarian.
On the other hand, Paul’s comments last year that “I don’t really think the government needs to be too involved with” marriage were decidedly libertarian in nature. Perhaps that is even his true position, and his more recent remarks have been more about rallying another wing of the GOP base. Whether he can get past the primary without clarifying remains to be seen.
As a final note, sophisticated social conservatives will argue that state maintenance of traditional marriage does not constitute an exercise of force, but merely an expression of what relationships the majority choose to recognize as “married” within the meaning of the law. The distinction is worthy of recognition and merits debate. However, states use force to collect taxpayer money to run their marriage licensing programs, and most libertarians intuitively support some version of “equal protection” doctrine.
In summary, to answer Sullum’s question, Paul’s position on when life becomes entitled to state protection is neither supported by nor contradicted by libertarian doctrine. If he thinks state legislatures can define marriage for individuals, however, Paul is far afield from basic libertarian tenets.
Does that mean I won’t vote for him?
No. I fully intend to vote for Rand Paul in the GOP primary. If he actually gets the nomination—and I hope he does—I may vote for him in the general as well. For one thing, I suspect that his true position on gay marriage is largely libertarian. Even if I am wrong about that, Rand Paul is still leagues more libertarian than any candidate the two major parties has run in my adult life.
I have never been lucky enough to be offered a candidate who both satisfies my politics and has a chance of winning. His imperfections notwithstanding, it would be nice if Rand Paul could change that.
Wisconsin Senate approves right-to-work bill, sends to state Assembly
BY BRENDAN O’BRIEN
The Wisconsin Senate narrowly approved a “right-to-work” bill on Wednesday that would bar private-sector employees who work under union-negotiated contracts from being required to join their unions or pay them dues.
The bill, which would make Wisconsin the 25th U.S. state with a right-to-work law on the books, cleared the Republican-led Senate on a 17-15 vote following hours of debate marked by periodic angry shouts from opponents in the Senate gallery.
Supporters of organized labor chanted “Shame!” as the legislation was passed and sent for further consideration to the state Assembly, where Republicans also hold a majority.
One Republican senator, Jerry Petrowski, broke with his party and joined all 14 Democrats in the chamber in voting against the measure.
Wisconsin Governor Scott Walker, a possible Republican presidential hopeful, is expected to sign the bill if it reaches his desk.
Walker drew accolades from conservatives across the nation in 2011 when he ushered through legislation curtailing the powers of most public-sector unions in Wisconsin amid large protests at the state capitol in Madison.
Supporters of the right-to-work measure contend it could attract more businesses to the Midwestern state.
“I think this is something that is going to have a direct impact on the manufacturing sector in Wisconsin,” Senate Republican leader Scott Fitzgerald said after the vote.
Opponents cast the bill as an assault on organized labor and blue-collar workers that would limit union revenues.
“They are evaporating the middle class, and no one in this room seems to care,” Senator Dave Hansen, a Democrat, said during the floor debate.
So ignore the rather clearly biased language in the piece and video linked above, if you bother clicking through and reading it… If you’ve seen one piece about the subject, you’ve pretty much seen them all, and this one is no different.
Wisconsin is debating “Right to Work” legislation in house committee right now, after passing in the senate. A right to work measure (which may or may not be substantially identical to the one passed by the senate) is likely to pass the house as well, and governor (and likely Republican presidential candidate) Scott Walker is likely to sign it.
As per usual, leftists are up in arms about anything that might favor individuals over organized labor…”Anti-worker, anti-poor, anti-little guy, anti-union, destroying the middle class, 1% evil” etc… etc…
Can someone tell me how making it illegal to force someone who doesn’t want to join a union, to join a union… is anti-union?
That’s all “right to work” means… You can’t be forced to join a union if you don’t want to, and employers can’t be forced by the government to recognize or deal with a particular union if they don’t want to.
The “right to work”, is simply the right to freely associate and form contracts as we choose, which is supposed to be a right guaranteed us in this country (of course, so often it is not… but that’s another issue entirely).
Wait… What? Unions can force people to join who don’t want to?
Yes, they can, and they do.
Most people don’t know this, but in 26 states, unions are given special powers and privileges by the government, which you as in individual, or a private company or other organization would not have.
One of these, is that you can be forced to join a union against your will, if you want to get a job in a particular industry, or at a particular employer, or to keep your job at an employer after a union comes in.
Worse, in some states, you can opt out of the union, but even if you do, the union can still take dues straight out of your paycheck against your will, as if you were a member. They can also negotiate for you against your will, and set the terms and conditions under which you work, against your will.
Of course, since you aren’t a member, even though they’re taking your money and controlling your job, you don’t get to vote in the union, control its decisions in any way, or get any of the benefits of membership. The union gets your money, and all the benefit as if you were a member, without actually having to be accountable to you at all. And there’s nothing you can do or say about it.
Oh and the union can then do things like use that money to get politicians you oppose elected, get legislation you oppose passed, and change the terms and conditions of your employment against your will, without your approval or consent.
In those same 26 states (as well as federally in some cases), employers can be forced to recognize and negotiate with a union, even if they don’t want to. In fact, even if the union doesn’t actually represent their employees in some cases, or only 50.01% of their employees decide that a particular union will represent them.
“Right to Work”, is about ending some of those, frankly insane, conditions that unions operate under.
… Or at least that’s what it’s supposed to be about… It doesn’t always end up that way, because politics is what it is, so you have to be careful and pay attention to the details…
In “right to work” states, unions are still free to form, recruit members, and to collectively bargain in those members interests with employers. Workers are still free to join unions. Employers are still free to negotiate terms and contracts with the union, and if the employers don’t want to negotiate, unions are still free to use the power of their membership to make the employer negotiate through strikes, work stoppages and slow downs, and other organized labor actions.
The only difference, is that the union just can’t FORCE anyone to join the union, or force employers to negotiate with the union, or get the government to do it for them.
Why is this a bad thing?
It isn’t. Straight up, it isn’t.
It’s not bad for employees, it’s not bad for employers, it’s not actually bad for the unions if the unions are doing what they’re supposed to be doing, It’s not bad for consumers who consume the goods and services these employers provide.
In fact, in reducing union overreach to whatever extent it may (probably not too much, but one can hope), and in reducing the overall cost of doing business in the state of Wisconsin, it’s likely to benefit consumers with lower prices, and potentially with more business and more jobs in the state
This doesn’t always work out… It has generally done so in relatively business friendly states like Tennessee, North and South Carolina, Georgia, Alabama (I said relatively… relative to Illinois, New York, Wisconsin etc..). In those states, which are right to work, non union manufacturing has generally done well, in some cases even boomed. Not only that, but wages have substantially increased in those areas, not crashed as predicted by unions.
Right to work has not had as positive an impact in say, Indiana, or Michigan (yes, Michigan has been right to work since 2012… and yes, organized labor is still having a collective fit over that fact), which are comparatively less business friendly, higher tax, higher regulatory burden, and higher cost of living. In fact, mostly, companies have used the change in status to help them get rid of legacy contracts which were burdening their bottom lines, and then move to other states.
That however isn’t really the fault of right to work… it’s the decades of anti-business regulation and being forced to accept bad union contracts (and to be fair, decades of bad management as well).
Overall, right to work in and of itself is not a negative for anyone… well… except two groups.
The only parties it’s bad for, are union officials, and the politicians they’re in bed with). The officials depend on the politicians to pass legislation that favors the union officials, in exchange the politicians depend on the officials for large donations, and the use of their organization for street level politics (campaign volunteers, donor lists, call lists, phone rooms, rally fillers, doorbell ringers etc…). Without the forced membership and dues, the union officials don’t have as much money to donate to those politicians in exchange for favors, nor as many warm bodies to throw at their campaigns.
Also, if people can leave the union at will, it means that those officials have to watch their steps, and actually be accountable to union members…. Unfortunately something which has proven to rarely be the case today.
Leaving aside the corruption angle, and even the economics of it…
Does “right to work” reduce unions power? Potentially yes, if people don’t want to join, or want to quit the union.
However, I don’t see that as a bad thing. Why would that be a bad thing?
If people don’t want to be members of the union, why should the union get more power? Or any power at all?
Shouldn’t a union get it’s power from the strength of it’s membership, who support it, and in turn are supported by it? Shouldn’t a union attract and retain members because they are effective at doing so?
If they can’t do that… why should the union exist at all?
If they CAN do that, then why do they need the government to force people to join, and force companies to negotiate with them exclusively?
If the unions actually do what they’re supposed to do, and what they say they do… Why is this even an issue?
Right… thought so…
Here’s the thing though… Even if it were a provable economic net negative, that actually did harm jobs and wages, and even if all of the horrible terrible no good very bad things unions and democrats claim of right to work were true…
…I would still be in favor of right to work.
It’s a question of individual rights
I generally favor right to work, because I’m in favor of fundamental individual rights, including, but definitely not limited to: freedom of conscience, freedom of association, freedom of self determination, the right to private property, the right to the fruits of ones labors, and the freedom to make contract as one sees fit.
I generally support right to work legislation, presuming that’s what it really is (as with all legislation, what it claims to be, is often nothing to do with what it is, so pay attention to the details), because no-one should be forced to join any organization against their will (even if it’s absolutely for their own good), and no organization should have the right to control others in the way unions do, without those persons consent (even if doing so is to those persons benefit). It really is that simple.
For that matter, in general, I oppose involuntary collectivism, and preventing involuntary collectivism is what “right to work” is supposed to be about.
I’m all for voluntary collectivism… absolutely 100%. If you agree and consent to be a part of a group, and to take action as part of that group, or be represented by that group, great. More power to you, and to them.
In fact, I’m all for unions. I think collective bargaining is a wonderful and powerful tool, and I wish more people across more industries and market segments would take advantage of it.
An aside… I’m not just blowing theoretical smoke here. I’ve got a personal stake in this, both as a matter of principal, and as a practical matter in my own profession.
The level of worker exploitation, and in general negative, harmful, and just plain stupid labor practices in information technology, my chosen profession, is absolutely despicable.
Employers routinely extract far more labor from employees than they are paying for, or than that is reasonable for employees quality of life or professional development; while at the same time deliberately suppressing those employees wages, and denying them opportunities for improvement or advancement.
… and we allow them to do this. We accept it, because we don’t believe we have the power to change it, or we feel too insecure to do so.
The only way these conditions are going to change, is if they obviously and clearly no longer work to increase profits or improve stock prices.
Actually, it’s been repeatedly and conclusively proven they not only don’t help, but they substantially harm organizations, including their bottom lines… but execs still love them because the stock market loves them (That’s another issue entirely)
That being the case, the only way needed change is going to happen, is if enough of us in the profession stop accepting these conditions, and do something about them.
A company can’t be pumping its stock prices, if it doesn’t have anyone keeping it’s computers and networks operational…. or at least not for more than a few weeks.
Stop working for companies that use these practices. Insist on being paid for our time. or in receiving compensatory time off. Report companies for labor law violations, and make sure the laws are properly and evenly applied, through the use of the media and political pressure (I think most labor laws are horrible and stupid and shouldn’t exist, but so long as they do, the greater tyranny is that they are applied capriciously and unevenly based on political whim, and lobbying).
Most importantly, as managers, leaders, and thought leaders in the industry, don’t allow and accept these practices in your own organization. When they pop up… and they will.. gather together, and pound them into the dust before they can take over.
One of the more effective ways we could do all of that, is with collective bargaining, and collective and consistent messaging to the media, and politicians (though sadly, I don’t think it’s likely to happen any time soon). Not necessarily a union, but some type of voluntary collective organization to increase our negotiation power and leverage, and help to prevent things like companies requiring hundreds of hours of uncompensated overtime.
If enough of us act… whether collectively or as individuals, we can force changes. Without enough of us acting in concert, we can’t… And if we can’t, we’re left depending on the government to “fix” things… and you know how I feel about that.
It’s when you take that choice away by force, that I have issues. Forced unionization is never OK… and that includes “democratic” forced unionization.
Just because you got a few dozen of your friends together and you all voted to give you the “right” to control everyone else, doesn’t actually give you the right to control everyone else. Even if there’s 50 million of you, and 1 of everyone else. Otherwise, there are no individual rights, only privileges and entitlements dispensed by the will of the majority. That’s no less tyranny than a dictatorship of one man… and in some ways is a greater one.
“Oh, but democracy is great. It’s the will of the majority, so you just have to go along”
Right… because giving more control over your life to everyone else is always a great idea, especially when jobs and money are at stake.
Giving your coworkers a vote on how much you can make, how much you can get paid per hour and how much of a raise you can get when, how many hours you can work, what tasks you can do, how you can do them, whether or not you can be promoted and when…
…Actually, often a veto, not just a vote…
And people like this idea why?
No thanks. Not up for that.
I have no problem with unions, in fact I think they’re great in theory, and I’d like to see a lot more of them, a lot more active, doing what they are supposed to be doing…
… So long As:
1. Participation (including fees or dues) is voluntary
2. They are not given special privileges or powers over individuals or employers by the government
3. Individuals and employers are free to negotiate and form contracts outside the union
4. The union cannot set the wages, benefits, conditions and terms of employment, and working conditions; for individuals or employers, without their consent.
If they’ve got consent for collective representation of all the workers, and the employer agrees to the conditions and terms… GREAT. That’s what collective bargaining is for.
Otherwise, what gives you or anyone else, the right to determine those things for me, my employer, or anyone else?
I am a cynically romantic optimistic pessimist. I am neither liberal, nor conservative. I am a (somewhat disgruntled) muscular minarchist… something like a constructive anarchist.
Basically what that means, is that I believe, all things being equal, responsible adults should be able to do whatever the hell they want to do, so long as nobody’s getting hurt, who isn’t paying extra
Does Doctor Rand Paul believe vaccines cause autism? Well, let’s see exactly what he said on the topic (video after the fold):
I’ve heard of many tragic cases of walking, talking, normal children who wound up with profound mental disorders after vaccines.
Really, Rand? You’ve heard of cases. Seems like you and my wife have something in common. As I like to say, I believe in evidence-based medicine, while she believes in anecdote-based medicine.
Of course, it’s not all that dangerous that my wife has this blind spot. She’s neither a doctor NOR a US Senator. You, however, should think before you open that hole on the front of your face and let words fall out. The world holds you to higher standard.
90% of your interview was extolling the virtues of vaccines. You make a great point about freedom. Vaccines ARE voluntary, which seemed to be a surprise to the anchor. We as parents must carefully weigh evidence and do what we believe is right for our children. I’ve argued as such here on this blog.
But this one sentence is going to be used as evidence that vaccines cause autism. Your position as a Senator and as a doctor are going to be used to give this idea credibility. Oh, and if you now come out and publicly try to distance yourself from this, the conspiracy-minded anti-vaxxers out there will view that as only damning you further.
And you base this on what? Anecdotes? Anecdotes from parents who are reeling from the emotional sting of realizing their perfect little child is facing a neurological disorder and the terror of what that will mean? Parents who wonder “why” life is unfair–and who is to blame? These parents are vulnerable, and some of the subcultures in the autism community will have them quickly believing that vaccines, antibiotics, and frankly anything sold by a pharmaceutical company is evil, and delivering them into the hands of pseudoscience hucksters selling hyperbaric oxygen treatments, chelation, and homeopathy as the solution. As the father of a child with autism, I’ve watched it happen. I don’t tend towards hyperbole in this area, but the behavior of many of these groups is remarkably cultlike.
I’m not sure what Sen. Paul truly believes as it relates to vaccines and autism. But he’s now entered the debate, and on the wrong side. He did so without evidence; merely anecdote.
On Monday, Senator Rand Paul (R-KY), a prospect for the 2016 Presidential Election, put forth his opinion on vaccinating children. It wasn’t Dr. Paul’s finest moment.
In light of the recent measles outbreak in California, Dr. Paul was asked about the disease, and the ant-vaccination movement, on Laura Ingraham’s radio show. He stated that while he felt vaccinations were a “good idea”, he felt that parents should have the option to decline them:
“I’m not arguing vaccines are a bad idea. I think they’re a good thing, but I think the parents should have some input,” he added. “The state doesn’t own your children. Parents own the children and it is an issue of freedom.”
Dr. Paul noted to Ms. Ingraham in his interview that he believed vaccinations should be optional. In the same show, Ms. Ingraham stated that she didn’t believe measles was “that big of a deal“.
Later in the day, in a CNBC interview, Dr. Paul used anecdotal evidence to state that parents were justified in their skepticism:
“I’ve heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines,” Paul, R-Ky., said in an interview with CNBC anchor Kelly Evans.
This coincides with fellow GOP hopeful Chris Christie, who explained that while he vaccinates his children and believes they are a good thing, believes parents deserve more input:
He said that he and his wife had vaccinated their children, describing that decision as “the best expression I can give you of my opinion.” He said they believe doing so is an “important part of making sure we protect their health and the public health.”
“But,” Christie added, “I also understand that parents need to have some measure of choice in things as well. So that’s the balance that the government has to decide.”
Mr. Christie made greater input into vaccinations for parents part of his campaign for Governor of New Jersey in 2009.
Some of these public statements of support for anti-vaccination proponents can be explained as a matter of timing: earlier in the morning, an interview the Today Show did with President Obama made clear his thoughts on the matter: there are no reasons not to vaccinate:
“I understand that there are families that in some cases are concerned about the effect of vaccinations. The science is, you know, pretty indisputable. We’ve looked at this again and again. There is every reason to get vaccinated, but there aren’t reasons to not,” the president explained.
Anti-vaccination proponents – often called “anti-vaxxers” – believe that vaccinations for many diseases once viewed as eradicated can cause mental defects, with autism being the most commonly referenced, due to the amount of mercury in the vaccinations. More fringe elements of the anti-vaxxer movement believe that the government intentionally puts mercury in vaccinations as a passive form of population control.
However, most anti-vaxxers, if I’m putting this bluntly, are not very smart. They read a few articles on Infowars, see Jenny McCarthy speak for twelve seconds, put on their finest tin-foil hats, and let loose their ridiculous, half baked ideas, just before their diatribe about chemtrails. These people are clearly cuckoo for Cocoa Puffs. But what’s truly harmful is to have people like Senator Paul – a DOCTOR, for heaven’s sake! – and Governor Christie (a successful lawyer) giving oxygen to these people by enabling their nonsense.
The argument being made is that parents should have the liberty to do whatever they want with their children. However, that argument ends at my child’s body. This isn’t something like school choice, or even a voucher program that would use tax dollars in religious schools against the wishes of secular parents. Not vaccinating a child against measles puts that child’s life in danger before they even know what measles are. They also put other children at risk, particularly other children who either are not vaccinated or can’t be vaccinated due to other health concerns.
It’s one thing to argue that a parent – or even a mature minor has the right to put a child at risk if they believe the treatment is worse than the disease; I’m sympathetic to that argument to an extent. But a measles epidemic has been cut loose for the first time since “Leave It To Beaver” was being taped, and it’s affected a lot of people. Parents affected who willingly did not vaccinate their children should be held liable for the damage they have personally caused.
It’s easy to call the anti-vaxxer issue a bipartisan one – thank the “Whole Foods crowd” for that – but this is a problem that is disproportionate among hardcore, anti-government right wingers, who have been raised into a froth into believing that anything involving the government, or Barack Obama, is a bad thing. Such constant pandering – particularly by grifters like Sarah Palin and others – replaces education with nonsense because to them, these “facts” are education. Due to this, they distrust anything that goes against their worldview. “The CDC!? Liberal media fascists!” If President Obama said the sky was blue in a speech, that would be the tinder that starts a purple sky movement.
We expect “I’ve heard it causes brain damage!” to come from the wingnuts. But coming from Doctor Paul, a very intelligent man, calls into question his sincerity, his respect for the American primary voter – part of me thinks “he can’t believe that shit, can he?” – and his qualification to hold the highest office in the country.1
1 – I’m not holding Governor Christie to so strong a flame because I feel his statements, and clarifications, exhibit more nuance than those of Dr. Paul, who is no stranger to some real whoppers in his time.
Christopher Bowen covered the video games industry for eight years before moving onto politics and general interest. He is the Editor in Chief of Gaming Bus, and has worked for Diehard GameFan, Daily Games News, TalkingAboutGames.com and has freelanced elsewhere. He is a “liberaltarian” – a liberal libertarian. A network engineer by trade, he lives in Derby CT.
The “A”CA – Good for Elites, Bad for the Middle Class
Contain the Cost of Healthcare and Preserve Options for the Middle Class
This is an issue that requires a bit of an introduction. We believe it is very important to recognize that our healthcare system is both incredible in its productivity and humanity…and very much broken. The middle and lower class see healthcare is a pressing concern because the cost to maintain insurance is getting high enough that it is forcing some serious and uncomfortable decisions onto struggling families who have to balance their budgets. The CBO estimates that, by the year 2045, the average American family will spend nearly 20% of its take-home pay on health insurance (about what they currently spend on their mortgage!). At the same time, unfunded liabilities to cover the cost of government-backed health programs like Medicare and Medicaid will soon account for 100% of all estimated tax revenue taken by the government. This is obviously an enormous problem. One that threatens to destroy our economy, cripple our access to quality care, and generally make us miserable in the not so distant future.
There are many theories for how we might go about solving this problem, but few of them have been fleshed out enough to back with the force of legislation. Prior to the bastardized half-breed of state-driven insurance mandates and taxes that is now commonly known as the Affordable Care Act, there were two competing visions for the future of healthcare in American. On the left, you had advocates for a single-payer state-run healthcare system as is common throughout the European Union and in Canada, among other places. On the right, you had advocates for transparency in healthcare service charges, tort reform, and interstate insurance commerce. The left’s concept would immediately be recognized by the American public as a massive tax hike. The right’s concept is a series of piecemeal, small-scale ideas that don’t sound like they can really fix the problem of out-of-control healthcare costs on their own.
The healthcare system has costs far beyond the basic ones associated with providing care directly. There are costs associated with:
• Medical Research and Development (and government regulation thereof)
o The research has basic costs
o The government heavily regulates how this research must proceed to get drugs and equipment to market
o The government research institutions try to assist in a wide variety of areas and this unfocused mandate yields inefficiencies
• Malpractice Insurance
o Private practice doctors report that something like half of their profits go straight to malpractice coverage because malpractice lawsuits now routinely go for huge payouts and the insurer must cover the cost
• Hospital Administration
o Here again, there are basic administration costs for running any healthcare business
o And then there are bloated government regulations that require record-keeping that rarely makes sense and is exceedingly expensive, while forcing administrators to retain fleets of expensive lawyers
• The Actual Medical Care
o Even here, there are basic costs…and then there are costs associated with doctors padding their bills to bilk the insurance companies (or at least to force them to pay out as much as they possibly can)
o And further, there is the cost of unpaid medical care given to people who are not insured and cannot pay
o And, ironically, there is the added cost of the government’s drive to get us to see our doctors more regularly (preventive care), which has yet to show any evidence of reducing expensive and undesirable health outcomes
• Insurance Company Administration
o And then we have the insurers – who are, themselves, heavily regulated by the government, and are also guilty of padding their bottom lines, and perhaps of paying out more than they should when doctors are overbilling
• American Status as Cost Sponge
o What I mean here – the US is doing most of the work to lead the way on new medical breakthroughs because countries running on single-payer systems or depending on US financial assistance to function cannot afford to do high end medical research – the result is that all of the world comes here to advance medical science (at great cost to our government research institutions), but we in the U.S. pay higher prices for all of the beneficial new drugs and technology they produce, because other places around the world can’t pay enough for big pharma and big med-tech to break even without us being charged far more
The ACA does, to its credit, recognize many of the places where profiteering, waste and excessive spending are occurring, but the liberal answer to each spending sore spot is the heavy hand of more regulation. Rather than just propose a series of bills the way we’ve done elsewhere in this series, we will explain what the ACA does about each sore spot and the risks that method poses vs. what the conservative counter should be. We’ll use the same bullets from above to organize our plan.
A) Medical R&D Costs
The ACA doesn’t specifically address medical research in a major way, other than to levy a medical device tax and make matters worse for research, but the common answer on the left is to move the cost out of the private sector and into increased government spending on the issue. This way, private sector companies can charge less for the drugs and technology they produce and the actual cost of the work can be spread among the taxpayers less obviously. The conservative approach would include carefully relaxing certain regulations on big pharma and big med-tech regarding the cumbersome and lengthy process to get from experimental drug to approved market-ready drug or experimental medical device to sales and reduce the scope and cost of the FDA. It would also include a restructuring of the NIH, CDC and other government health researchers to significantly narrow their focuses and cut the sugar out of their research diets. And finally, the GOP approach should include a repeal of the medical device tax in the ACA.
B) Medical Malpractice
The ACA doesn’t even tackle the cost of malpractice insurance for private practitioners or legal counsel for hospitals – one of its most disappointing failures, but one that is understandable, considering that the Federal Legislature can’t really regulate state civil courts). The left has, traditionally, completely ignored the increasing need for tort reform. Unfortunately, so has the right. Every once in a while, you’ll hear a Republican talk about the need for it, but they tend to be economists, rather than politicians with any clout. The GOP must act now to enact stiff limits on settlement amounts in medical malpractice cases in the states. We recognize that medical mistakes are always extremely damaging and life-altering (or ending) for their victims. We also recognize that the legal system shouldn’t be a lotto-draw for someone looking to get even with a doctor or make a quick killing after a mistake. The GOP should also enact “loser pays” laws for all civil matters, including medical malpractice. Unfortunately, these are generally matters reserved for the states, and the GOP must spearhead the effort at the state level to address them.
C) Hospital Administration and Record-Keeping
The ACA likely made these costs much worse, I’m afraid, by changing medical billing codes to a ludicrous, byzantine array of unrecognizable codes and further regulating how this information is to be collected. The GOP should move to vastly simplify medical insurance/incident/billing codes, and take a more holistic approach to auditing hospital financial and medical records.
D) Medical Fees and Insurance Models
As we know, the ACA attempts to decrease the number of people who are uninsured and thus to lower the liabilities for hospitals who must treat all patients, whether or not they are insured, by requiring that everyone get health insurance and taxing you if you do not. On top of this, the ACA requires all businesses of a certain size (more than 50 full time employees) to offer health insurance or pay massive fees. The ACA requires that children under the age of 26 be allowed to remain covered by their parents. And it requires that insurance companies never reject someone who has a pre-existing condition. And finally, the ACA requires that those plans cover a huge range of medical services in an attempt to capture all of the potential costs. The theory was that young, healthy people were going uninsured to avoid paying for it when they felt invincible at rates high enough to balance out all of the people who’d been rejected for preexisting conditions. The mandate-driven approach has proved to be a spectacular failure. Many are choosing to pay the tax – especially the healthy – many more are finding that their plans are far too expensive and have huge deductibles as insurance companies look for ways to shield themselves from the increased cost of covering high risk people. And, of course, if the government is forcing the insurers to cover everyone, many insurers will drop out of the marketplace, and that is exactly what is happening.
Having said all of that, we do not think that every idea in the ACA is bad and we do not think it is necessarily the best approach to wholesale repeal it at this point. We believe that there should be a national program to provide everyone with catastrophic insurance (to protect hospitals for huge unpaid bills, and patients from bills that ruin them financially). We also believe “guaranteed issue” and the clause extending coverage to children under the age of 26 are popular because they are necessary. We even believe the idea of a national health insurance marketplace is a very good one (we wouldn’t have the government running it, we’d set up a cooperation between the various health insurance providers and let a private company maintain the marketplace). Here is what a conservative plan would look like:
• Repeal the individual and employer mandates
• Require all Americans to buy catastrophic coverage plans the same way we require them to buy at least minimal collision insurance if they drive
• Nationalize the healthcare market (no more state insurance networks; this is not simply “selling across state lines”, this is true nationalization) and allow insurers to offer a la carte supplemental coverage – if you need coverage for prenatal care, you buy it; if you need coverage for prescription drugs, you buy it, etc.
• Require healthcare providers (private doctors and hospitals and clinics) to publicly announce their price points on a government-managed website for all of their procedures to allow consumers to price compare instead of being blind to the cost – market awareness frequently leads to market efficiency
• Require insurers to similarly announce what they’ll pay out for given procedures (in an attempt to prevent the sort of “doctor charges way too much to max out what the insurer will pay out” games we previously mentioned)
• Give tax credits to people who buy preventive care packages and repeal the Cadillac tax
• Enact the Ryan/Wyden plan for Medicare
E) Insurance Company Administration
The ACA includes a bunch of downright frightening top-down controls in an attempt to reign in insurance payouts for Medicare (because retired people are expensive, health wise, and paid for on the government dime), including but not limited to yet another in a long line of ill-advised price-fixing schemes promulgated by the left. They keep trying to fix the market to their liking and it keeps going spectacularly wrong and cause misery every time. This time, I’m referring to the Independent Payment Advisory Board. While I would stop short of calling it a ‘death panel’, there is excellent reason to fear this entity and its impact on the end of life process. IPAB will basically regulate insurance company payouts to Medicare by fiat, which will cause doctors and hospitals to begin to refuse to perform certain procedures, leading to a downward spiral in the quality of care for the elderly. We saw a glimpse of this with the VA – where aging WWII and Korean War veterans were being denied access to treatments and redirected to hospice care in some cases. The left sees the IPAB as a way to end insurance company inefficiency and doesn’t understand why this process should lead inexorably to premature death in some cases, but we have many examples – starting with the British National Health Service. The conservative answer to insurance company bloat and overpayment is, as noted above, to improve price transparency and let the customers straighten out the market. We would also add that government could play a role here with some far less heavy-handed regulations on payouts based on the going market rate for the service, once the service itself is priced publicly. Data is power – market data leads to a powerful market. Either way, the IPAB must be dismantled as soon as possible.
We’ve laid out many proposals here that attempt to make healthcare decisions less costly and stressful for the middle class, but rest assured, we’ve barely scratched the surface. We are hoping that this will start a dialogue among conservatives as to what sort of healthcare platform GOP Congressmen should build heading into 2016.